Critical Care |

Mobilizing the Patient in the ICU: Survey of the Barriers in Translating Knowledge to Practice FREE TO VIEW

David Anekwe, MS; Michel de Marchie, MD; Jadranka Spahija, PhD
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Jewish General Hospital, McGill University, Montreal, QC, Canada

Chest. 2015;148(4_MeetingAbstracts):218A. doi:10.1378/chest.2278654
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SESSION TITLE: Critical Care Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Sunday, October 25, 2015 at 01:30 PM - 03:00 PM

PURPOSE: There is increasing evidence that early mobilization (EM) is safe, feasible and associated with better outcomes in patients with critical illness. To translate the emerging evidence into clinical practice, there is need to characterize the current knowledge and practice of ICU clinicians, and to assess the barriers and facilitators to this practice. The objective of this study was to assess the knowledge and practice patterns of ICU clinicians, as well as the barriers and facilitators to EM in Montreal area ICUs.

METHODS: We surveyed 274 nurses, physicians (MDs), respiratory therapists (RTs), and physiotherapists (PTs) who had at least 6 months experience working in three Montreal ICUs using the mobility survey tool questionnaire.

RESULTS: The overall response rate was 50.0% (137/274) [75.0%, 59.2%, 56.0% and 35.9% of surveyed PTs, nurses, MDs, and RTs, respectively]. Although 65% of clinicians stated that they were familiar with the literature on EM, 40.6% were aware of the incidence of ICU acquired weakness, and only 3.6% provided correct responses to all 5 questions on the benefits of EM as shown by clinical trials. From all respondents, 42.0% felt they were sufficiently trained to mobilize mechanically ventilated patients, and 33.3% reported that there was a written protocol to guide EM in their ICU. Participants responded that a wide range of physiotherapy techniques were used in their ICUs, although neuromuscular electrical stimulation, treadmill, cycle ergometer and dynamic tilt table are never or rarely used. Insufficient equipment and lack of guidelines for EM were rated as the highest institutional barriers, medical instability and risk of dislodgement of lines the greatest patient level barriers, while safety concerns and limited staffing the greatest provider barrier. Only in one ICU did over half (67.5%) of respondents say that they had a champion for EM and this champion was a nurse.

CONCLUSIONS: Our survey shows limited awareness of the clinical benefits of EM, and lack of self-efficacy in the clinical practice of EM in over half of our respondents.

CLINICAL IMPLICATIONS: Knowledge of the potential benefits of EM and self-efficacy in this practice are necessary if clinicians are to implement the emerging knowledge into clinical practice.

DISCLOSURE: The following authors have nothing to disclose: David Anekwe, Michel de Marchie, Jadranka Spahija

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